Original Article

Allocation of Nursing Time at University Hospitals in Japan
Katsuya Kanda*1 , Mieko Ozawa*2 , Rumiko Irimura*3【Abstract】 Objectives: To investigate the current status of nursing care and services provided by nursing personnel working atuniversity hospitals; and to obtain information to address nursing issues, such as reexamining the current and proposed nursing
service systems and improving the delivery of nursing care at university hospitals.
Sample and Method: A convenient sample of 16 national university hospitals was selected after considering each hospital's regional
location and year established. The data were collected between May and June in 1995 with a self-administered time survey on
individual nursing personnel (conducted on two weekdays and one Sunday) and on individual patients (data included all inpatient
direct care time on one weekday).
Results: The average bed size of the participating hospitals was 830. The average numbers of working nursing personnel andinpatients on the survey days were 296 and 719 on the weekdays, respectively, and 193 and 690 on the Sunday, respectively. The
frequency of "the most critical" patients (who must always be on bed-rest and require continuous observation) comprised 10% on theweekdays and 8% on the Sunday. On the weekdays, the most frequently provided care was "taking care of patients," comprising 30%
of total work hours, followed by "charting, reporting, and staff communication" (25%) and "assisting medical examination andtreatment" (14%). The proportions of these types of care on the Sunday were 34%, 27%, and 16%, respectively. The average direct
patient care time per inpatient on the individual patients-survey day was 107 minutes (work shift distributions: 55% [day]; 26%[evening]; and 18% [night]). Patients with a higher nursing acuity level had a smaller difference in direct patient care time between the
day shift and the evening and night shifts.
Conclusion: Nursing personnel in university hospitals allocated nearly 50% of their nursing time to direct patient care, which is afavorable effect of the ongoing improvements in nursing care delivery systems. The survey results provide baseline data for future
directions of improvements in nursing service at university hospitals and benchmark data to evaluate the current quality of nursing at
tertiary care hospitals.
Keywords

nursing time, university hospital, direct care, self-administered survey

Introduction

hospitals serve a high number of critically or intractably ill

Nursing is one of the significant determinants that make anpatient populations2). Nursing staff assignments in university

impact on the quality of care and patient outcomes in acute care

hospitals are arranged in such a way that meets high demands

settings

1).

An effective use of nursing staff in acute caresettings is one of the priorities in nursing management.

for diverse patient care needs3). An increased level of severity
among inpatients at university hospitals in recent years has

University hospitals provide opportunities for patients' healthbrought about an increased number of patients with multiple

care and treatment, as well as health care professionals'

comorbidities,

educational and research endeavors. Therefore, university

pathophysiology, and an advanced and complex diagnostic and*1Adjunct Lecturer, National College of Nursing, Japan*2Associate Professor, National College of Nursing, Japan(Associate Professor, Graduate School of Medicine,
The University of Tokyo)
Correspondence:Katsuya Kanda, Departmentof Nursing Administration, Graduate Schoolof Medicne, The University of Tokyo,
Tokyo, 113-0033, Japan.
e-mail:kanda-tky@umin.ac.jp*3Director of Nursing, The University of Tokyo Hospital― 17 ―

anincreasedcomplexityofpatients'

J Nurs Studies N C N J Vol.1 No.1 2002

treatment technology. Given this context, an advanced and well-

Procedures and Measures:
The data were collected with a self-administered survey thatskilled level of nursing care is required in university hospitals.
A variety of political measures aimed at improving nursing

employed the authors' developed uniform record. A site

services have been taken since the late 1980s when Japan

coordinator at each participating hospital was asked to collect4),5).

Severalall completed records and mail them to the authors. The

improvements in nursing services at university hospitals

variables and measurements collected are described in the

included: greater use of computers; introducing labor-saving

following sections.

experiencedaseriousnursing

shortagemachines and equipment; delegating some tasks to support
personnel; and increasing the regular number of nurses.

The

following

variables

relatedtoeachhospital's

characteristics were collected on the survey days: the number

The survey in this study was conducted with the followingof utilized beds; the number of inpatients; the number ofaims: to investigate the current status of nursing care andhealthy newborn babies; and the number of nursing personnel

services performed by nursing personnel working at university-(including the frequency of job types [nurses, assistant nurses,

affiliated hospitals; and to obtain information to address

and nurses' aids] and salary classifications). Individual nursing

nursing issues, such as reexamining the current and proposed

personnel's salary classification, age, and official work hours

nursing service systems and improving the delivery of nursing

on the survey days (starting time to finishing time) were alsocare at university-affiliated hospitals. The principal agent of therecorded. The following variables were collected in relation tosurvey was the Committee of Nursing Directors at National

the characteristics of inpatients: the type of primary medical

University Hospitals (Hiroko Moriyama, Chair at the time ofdepartment responsible for the patients' treatment; gender; age;the survey in 1995) and the Subcommittee for the Survey ofnursing acuity level (described below); the total number of

Nursing Care (H. Moriyama, Chair). The three authors were inpatients admitted and discharged; the type of "special" beds

charge of designing, planning, coordinating, conducting, and(i.e., for aseptic treatments, infectious diseases, intensive careanalyzing the survey in collaboration with the committees.

units, neonatal intensive care units and emergency rooms, etc.);
an addition of reimbursement for high-acuity care; the number

Methodof beds in each patient's room; the number of family caregivers

Setting and Sample:

staying with their patients in hospitals; and reasons for the

The sample of the study included 16 out of 42 main

hospital-staying family caregivers.

hospitals affiliated with national universities in Japan. This

The data for the time survey of nursing care were collected

convenient sample was selected after considering eachwith a self-administered uniform record for individual nursing

hospital's regional location and year established.

personnel, enabling each personnel to record her/his care

The data for the time survey of nursing care were collected

performed in chronological order. Items recorded in this survey

from all individual nursing personnel in all units of the

include: the starting and finishing times of each careparticipating hospitals. This time survey of nursing care was

performed; the types of care performed; the locations of careconducted on two consecutive weekdays (Wednesday andperformed; and the recipients (patients) of care provided. The

Thursday, referred to as "the weekdays"), and one Sunday

types of care were coded by the authors' modified (updated)(referred to as "the Sunday") between May and June in 1995.

version of the nursing care classification system originally

The data for the time survey of patient direct care weredeveloped for the survey on nursing care at national university

collected from all individual inpatients and healthy newborn

hospitals in 1987.

babies hospitalized in all units of the participating hospitals on

The data for the time survey of individual patient direct care

one Wednesday in June 1995. Two hospitals needed to arrange

were collected with a self-administered uniform record for

different days for the surveys due to administrative reasons in

nursing personnel, the other healthcare providers and hospitaleach hospital. The investigators adhered to the pre-set

employees (other than nursing personnel), and family

principles in order to arrange survey days for these two

caregivers who provided direct care to individual patients.

hospitals (i.e., the time survey of nursing care is conducted on

They recorded the following items in chronological order: thetwo consecutive weekdays and one Sunday; the time survey ofstarting and finishing times of each direct care provided to eachdirect care is conducted on a weekday).

patient; the type of care provided; the type of care providers/

国立看護大学校 紀要 第 1 巻 第 1 号 2002 年― 18 ―

Nursing Time at University Hospitals

caregivers; and the number of care providers/caregivers present

be high among large hospitals with a utilized bed size of 1,000

at each patient's bedside at each care occurrence. The type ofor more.

care was coded by the above-mentioned nursing careclassification system.

The average number of inpatients at the 16 hospitals on theweekdays of the time survey on individual nursing personnel
was 719; the number of inpatients per nursing personnel

Analysis:working on the weekdays was 2.65. The average number of

The time of each care performed by nursing personnel was

inpatients at the 16 hospitals on the Sunday was 690; thecalculated from the time survey data of individual nursing

number of inpatients per nursing personnel working on the

personnel. The missing data on starting or finishing times were

Sunday was 3.92.

excluded from the analysis. The data for the weekdays were
defined as the means of the two-weekday data in the individual

Nursing Time per Day per Each Type of Care Services:
Table 1 shows the frequency of each nursing time spent by

nursing personnel's time survey.
The data from the individual patient's time survey were usednursing personnel on the weekdays and the Sunday.

only for the analysis in relation to the direct patient care time.

The most frequent type of care was direct care of "taking

Inpatients transferred to another unit or those inpatientscare of patients," comprising 30% of the weekday work hours

temporarily staying at home on the survey days were excluded(a range of 26% to 35%) and 34% of the Sunday work hours (afrom the analysis of the individual patient's time survey. The

range of 28% to 40%). The second most frequent type of care

total direct care time spent by nursing personnel and familywascaregivers was summarized, excluding direct care provided bycommunication," comprising 25% of the weekday work hours

physicians and other healthcare providers or hospital(a range of 23% to 29%) and 27% of the Sunday work hours (aemployees (other than nursing personnel). An unknown (orrange of 21% to 30%). This was followed by direct care of

missing) duration of direct care was replaced with 0.5 minutes.

"assisting medical examination and treatment," comprising

The total amount of direct care time was also calculated from

14% of the weekday work hours (a range of 11% to 18%) andthe time survey of individual nursing personnel. These times

16% of the Sunday work hours (a range of 13% to 22%).

indirectcareof"charting,reporting,

and

staff

were calculated in two different methods and compared;

A nurse's work shift from 8:00 to 16:00 was designated as

possible reasons for the differences between the two calculated"the day shift." A work shift from 16:00 to 24:00 wastimes were examined.

designated as "the evening shift." A work shift from 24:00 to

In this paper, "an average of 16 university hospitals" refers

8:00 was designated as "the night shift." The time spent for

to a weighted mean of values obtained from the 16 university

direct care of "taking care of patients" and "assisting medical

hospitals. The values shown in the tables were counted

examination and treatment" did not change significantly acrossfractions of .5 and over as a unit and casted away the rest.

the different work shifts. However, the time spent for "charting,

Therefore, the total of each frequency may not be equal to thereporting, and staff communication" during the evening andtotal number reported. The Statistical Package of Socialnight shifts was longer than that of the day shift.
The time spent with individual patient direct care on the

Science (SPSS) for Windows version 6.1 was used for the

weekdays was longer than that of the Sunday, partly because ofstatistical analysis of this study.

the higher number of nursing personnel at work on the
Results

weekdays than that of the Sunday. For example, the time spent

The Staffing of Nursing Personnel:

for "taking care of patients" was 64 minutes per inpatient on

The average bed size of the participating 16 university

the weekdays (a range of 55 to 76 minutes), whereas it was 47

hospitals was 830. The average numbers of nursing personnel

minutes on the Sunday (a range of 38 to 61 minutes). The timeworking at the 16 hospitals on the days of the time survey on

spent for "assisting medical examination and treatment" was 30

individual nursing personnel were 271 on the weekdays andminutes on the weekdays (a range of 26 to 35 minutes),

176 on the Sunday. The ratios of temporarily employed nursing

whereas it was 22 minutes on the Sunday (a range of 18 to 29

personnel were 7% on the weekdays and 4% on the Sunday.

minutes).

The ratio of temporarily employed nursing personnel tended to― 19 ―J Nurs Studies N C N J Vol.1 No.1 2002

Table 1：The percentage of nursing service time spent by nursing personnel: Distribution by the survey days, work
shift, and types of care
Types of care

The total in 24
hours

Work shift
Day

Evening

Night

The weekdays
Direct patient care
Taking care of patients

30

31

29

32

Assisting medical diagnosis and treatment

14

15

14

14

25

21

31

28

Indirect patient care
Charting, reporting, and staff communication
Clerical work

4

5

3

2

Messenger work

2

2

1

0

Administrative work

3

4

3

1

Staff education

2

2

2

1

Housekeeping

2

3

2

2

Maintenance of medical devise/equipment

3

4

3

2

Miscellaneous

5

4

5

6

Meals or break

9

10

5

11

Total (the weekdays)

100

100

100

100

The Sunday
Direct patient care
Taking care of patients

34

35

34

32

Assisting medical diagnosis and treatment

16

17

15

14

27

24

31

27

Indirect patient care
Charting, reporting, and staff communication
Clerical work

2

2

2

2

Messengers work

1

1

0

0

Administrative work

1

1

1

1

Staff education

0

0

0

0

Housekeeping work

2

2

2

2

Maintenance of medical devise/equipment

3

4

3

3

Miscellaneous

4

3

4

5

Meals or break

10

10

7

12

Total (the Sunday)

100

100

100

100

Work shift: Day = 8:00 to 16:00; evening = 16:00 to 24:00; night = 24:00 to 8:00

The Distribution of Nursing Acuity Levels:

required to "rest in a bed constantly;" level "2" means that a

Table 2 shows the total number of patients at each of thepatient "can assume an upright position in bed;" level "3"nursing acuity levels. The nursing acuity levels are classified

means that a patient "can walk inside a room;" and level "4"

into 12 types, depending upon the required frequencies (themeans that a patient "has no limitations on his/her dailylevels of needs) for nursing observations (levels "A," "B," andactivities.""C") and the levels of patient physical function and daily

The frequency of "the most critical" patients classified as theactivities permitted (levels "1," "2," "3," and "4"). Level "A"nursing acuity level of "A-1" comprised 10% on the weekdaysmeans that a patient requires "continuous observation;" leveland 8% on the Sunday. The frequency of the "A-1" patients in"B" means that a patient requires "observation every 1 to 2each hospital ranged between 4% and 16% on the weekdays

hours; " and level "C" means that a patient "does not requireand 3% and 14% on the Sunday, with a difference of more thanregularly scheduled observation." Level "1" of physical

10% found among the sample hospitals. The frequency offunction and daily activities permitted means that a patient is"critical" patients, generally defined as patients with nursing

国立看護大学校 紀要 第 1 巻 第 1 号 2002 年― 20 ―

Nursing Time at University Hospitals

per day in each of the participating hospitals was 82 minutes

Table 2：Patient distribution by nursing acuity levels

and 152 minutes, respectively; the direct patient care time
Nursing acuity levels

The weekdays

The Sunday

ranged from 43 to 80 minutes in the day shifts, from 22 to 39

A-1

10

8

A-2

3

3

A-3

2

2

night shifts; and direct patient care time spent during the

A-4

2

2

evening and night shifts comprised between 40% and 48% of

B-1

6

6

the total direct care time.

B-2

9

9

Each of the participating hospital's average direct patient

B-3

20

21

care time ranged from 177 to 310 minutes for a group of

B-4

9

9

C-1

1

1

C-2

2

2

C-3

15

16

ranged from 86 to 152 minutes during the day shift, 51 to 82

minutes in the evening shifts, from 14 to 33 minutes in the"critical" patients with nursing acuity levels of "A-1," "A-2,"
and "B-1." Direct patient care time for "critical" patients

C-4

21

20

minutes during the evening shift, and 32 to 77 minutes in the

Unknown

1

1night shift. Direct patient care time spent during the evening

Total

100

100

and night shifts was very high (between 43% and 51%).

Nursing acuity levels: “A”= a patient requires continuous
observation; “B”= a patient requires observation every 1 to 2
hours; “C”= a patient does not require regularly scheduled
observation; “1”= a patient is required to rest in a bed
constantly; “2”= a patient can assume an upright position in
bed; “3”= a patient can walk inside a room; “4”= a patient
has no limitations on his/her daily activities.

The proportion of time spent during the evening and night
shifts tended to be higher in the group of "the most critical"
patients with a nursing acuity level of "A-1." Each of theparticipating hospital's average direct patient care time forpatient groups "A-1" ranged from 233 to 413 minutes in a totalof 24 hours. Direct patient care time in each work shift was asacuity levels of "A-1," "A-2," and "B-1," ranged from 11% to
29% on the weekdays and from 10% to 26% on the Sunday,with a difference of more than 15% found among the sample

follows: 96 to 187 minutes during the day shift; 64 to 128
minutes during the evening shift; and 41 to 118 minutes during
the night shift. The time spent for "the most critical (A-1)"
patients during the evening and night shifts had a much higher

hospitals.

range (from 44 to 59%) than that of the "critical (A-1, A-2, andB-1)" patients. Additionally, direct patient care time spent for

Direct Patient Care Time in Each of the Nurses' Work Shift:
Table 3 compares the direct patient care time (i.e., "taking
care of patients" and "assisting medical examination andtreatment") per inpatient per day from the time survey of"A-1" patients during the evening and night shift in 10 of theparticipating hospitals (out of 16 in total) comprised more than
50% of direct patient care time.

individual nursing personnel and the time survey of individual
Discussion

inpatients. The time survey of individual inpatients included
direct patient care provided by hospital-staying family

Time for Nursing Care and Services:
The ratios of direct patient care time, including "taking care

caregivers, which comprised 7% of the total direct patient caretime. After excluding this direct patient care time provided byfamily caregivers, direct patient care time per inpatient per day
became 99 minutes, which was very close to 94 minutes of
direct patient care time, according to the time survey ofindividual nursing personnel. A recent trend indicates a steep
decrease in the number of family caregivers staying atof patients" and "assisting medical examination and treatment"in this study, were 45% on the weekdays and 50% on the
Sunday. The duration of direct patient care time per inpatientwas 52 minutes in the day shift, 25 minutes in the evening shift,and 17 minutes in the night shift in this study. The literature
was reviewed regarding the ratio of direct care time in total
nursing time at hospitals affiliated with universities or

hospitals. This trend needs to be clarified in future surveys.
The results of the time survey of individual inpatients were

academic institutions.
An observational work sampling survey (recorded at

as follows: the average number of inpatients on the survey day
was 712; the minimum and maximum direct patient care timeintervals of 1 minute) conducted in 1992 at a university
hospital in Japan showed direct patient care time of 34%6). An― 21 ―J Nurs Studies N C N J Vol.1 No.1 2002

Table 3：Patient direct care time (minutes) spent per individual patient: Comparison by work shift and survey methods
The data from the time survey ofindividual nursing personnel
Work shift

The weekdays

The total in 24

The Sunday

94

Day

The data from the time survey of individual
inpatients52

All patients

69
31"Critical"
patients a"The mostcritical"patients b

107

237

297

(8)

(23)

(23)

59

122

145

Evening

25

21

28

66

86

Night

17

16

20

49

66

Note: Numbers in parenthesis are portions of total minutes spent for direct patient care provided by hospital-staying family
caregivers.
Work shift: Day = 8:00 to 16:00; evening = 16:00 to 24:00; night = 24:00 to 8:00.
a Patients with nursing acuity levels of A-1, A-2, and B-1
b Patients with nursing acuity level of A-1

observational work sampling survey (recorded at intervals of

Another possible reason for the difference of the direct care

15 minutes) conducted at a tertiary care teaching facility intime ratio may be attributed to the difference between

1988 in the U.S. showed direct care time of 29% to 34% on

observational and self-administered methods. According to7). The results of the same study

weekdays and 34% on Sunday

Burke and associates10), however, little difference of allocatedalso showed that direct care time per inpatient was 31 minutes

time can be found between these two different methods, asin the day shift and 25 minutes in the evening shift. The results

long as the categories of nursing services and care areof another observational work sampling study (recorded atclassified in a broad way.

intervals of 10 or 15 minutes) conducted at two U.S. teaching
hospitals around 1990 showed that direct patient care

Messenger Service:

comprised 43% and 46% of the total nursing time8).

The proportions of time spent for messenger services were

Given these comparisons in the literature, the ratio of direct

only 1.6% on the weekdays and 0.6% on the Sunday;

care time in total nursing time is larger, and direct care time permessenger service in nursing is ranked as the first thing to be

inpatient is longer as compared to those results of studies

discarded. When the condition of a patient seriously

conducted in the past. The ratio of direct patient care time indeteriorates, increased utilization of emergency messenger

this study was much higher than that of the above-mentioned

services can be expected, especially on Sundays or during

relevant study conducted in Japan, which included only onenight-time shifts (i.e., carrying emergency drugs or medical

university hospital as a sample. However, attention must be

supplies, carrying specimens for emergency exams or lab

paid to regarding the difference of survey methods.

tests). It may be surmised that such messenger services can be9)compared the percentages ofdelegated to other hospital supporting staff. On the other hand,

direct patient care in eight time allocation studies conducted in

it may also be difficult to secure a certain number of staff

the past. Out of these eight studies reviewed, six studies withmembers who are responsible for such messenger services

similar job classification methods revealed the following

during night-time shifts if such service demands are

results. The ratio of direct patient care time obtained by aoccasional, yet have emergency needs. However, an urgent

continuous observational method (43%) was higher than thatdemand of messenger services is created by a sudden andobtained by work sampling methods (ranging from 31% tocritical change in a patient's condition, which requires36%). A self-administered survey with a continuous recording

increased direct care time for the patient at the unit level. An

method employed in this study had no interruptions; therefore,

introduction or improvement

this method is similar to the continuous observational method,equipment may be warranted; such a support system forwhich may be able to detect a record of longer direct care time

nursing personnel enables them to stay focused on direct

than a work sampling method.

patient care.

Prescott and colleagues

国立看護大学校 紀要 第 1 巻 第 1 号 2002 年― 22 ―

ofautomated messenger

Nursing Time at University Hospitals

A Need to Improve Night Shift Nurse Staffing:nursing care, regardless of the time of day or night.

Currently, no national standards are available as to a safe

Additionally, nursing units with a high demand for direct

and appropriate nurse staffing level. As is the case with other

patient care obviously have a high demand for indirect patient

countries, Japanese university hospitals that provide the mostcare as well. Therefore, a higher number of critically ill

advanced health care in the country assign a higher number ofpatients bring about a rapid increase in nurses' workload during

nursing personnel than other hospitals in order to take care of athe night shift. If the number of critically ill patients keeps2),3). As is also the casehigher number of critically ill patients

increasing in the future, a significant increase in nursing timewith other developed countries, health care reform has been

during the night shift is expected; the system of nurses' night

one of the major socio-political concerns in Japan. The major

shift work has to be reexamined carefully.

focus of the proposed health care reform includes shortening
the length of hospital stay (which had tended to be longer thanCharting, Reporting, and Staff Communication:necessary) and functional differentiation of health care"Charting, reporting, and staff communication" comprised

facilities (i.e., drawing a clear line among primary andthe majority of indirect patient care time and 28% of the total

preventive care clinics, standard health care facilities, andnursing time. The item of "charting, reporting, and staff

specialized/advanced health care facilities). Under such

communication" included sub-items, such as "nursing record

circumstances, momentum to shorten the average length ofcharting (writing cardexes, nursing summaries)," "nursing care

hospital stay is being promoted by university hospitals. The

planning (collecting information, conferences)," and "shift

number of nurses assigned to each patient in hospital (acute

reporting." These three sub-items are the principal componentscare) settings is very low in Japan compared to the level of thein nursing, with the exception of mandatory documentation andU.S., where the average length of stay is the shortest in thecommunication required by law. A high quality of nursing careworld. The low number of nurses assigned to each patient (lowcannot be provided to patients unless individualized andnurse-to-patient ratio) is obviously problematic in terms ofappropriate nursing care plans are arranged. Additionally,

patient safety and efficacy of care. Shortening the length ofcollecting the necessary patient information through routine

hospital stay with the current low nurse-to-patient ratio inand daily assessments and interactions with patients, as well asJapan is very difficult and dangerous to patients.

evaluating this information from multiple nurses' perspectives,

The results of the survey conducted at a tertiary careenables the appropriate arrangement of nursing care plans.

teaching facility in the U.S. in 1988 (as cited above) showed

Nurses' shift reporting is not meant to be a long one, conveyingthat the number of nurses at work during the day and evening

unnecessary information to other nurses. Instead, nurses' shift

shifts was a total of 9.18 in a unit, which held an average ofreporting can be utilized as an opportunity to educate new7). The number

25.12 inpatients (i.e., 2.74 inpatients per nurse)

graduate nurses about effective care plans for patients or toof inpatients per nursing personnel at work in this survey wasconvey main ideas of nursing care plans effectively to other

2.65. The results of the above-mentioned U.S. survey, however,nurses working in subsequent shifts. Therefore, these three

may reflect the time of a significant nursing shortage, where

sub-item activities (charting, nursing care planning, andthe number of clinical support personnel (licensed practicalreporting) should be evaluated in light of "improving thenurses or nursing attendants) was less than one per each work

quality of patient care with the amount of time spent for theseshift. After considering these situations, the level of nurse

activities" instead of simply being evaluated regarding "thestaffing in this survey (which includes night shift nursing

amount of time spent for these activities."

personnel) is not very high compared to that of comparable
U.S. hospitals in that survey.

All of the participating hospitals allocated between 18% and
25% of the weekdays nursing time and between 17 and 27% ofPatients with a higher level of severity apparently require a

the Sunday nursing time to these three sub-item activities. We

longer direct patient care time than those with a lower level ofneed to reexamine if arranged nursing care plans and recorded

severity; such groups of critically ill patients also requireand conveyed patient information during this amount of time

longer direct patient care time during the night shift comparedare effectively utilized for patient care that takes place

to patients with less severe condition. In other words, a group

afterward. There are many hospitals where nurses complainof severely ill patients require continuous observation andabout the burden of spending a long time for "nursing record― 23 ―J Nurs Studies N C N J Vol.1 No.1 2002

charting" (e.g., cardexes, nursing summaries). We can assume aout of bed as early as possible), the length of continuous bed-

situation where nurses are taking care of higher numbers ofrest after surgery has decreased dramatically. This kind of

inpatients than what they can handle within their official work

situation, therefore, may cause frequent changes in nursing

hours; as a result of this, nurses have spent a considerable

acuity levels; thus, the current practice of evaluating nursing

amount of time for "recording information that is necessary toacuity levels "once-a-day" may not be sufficient to pick up

simply fill out the forms for nursing care planning, charting/such frequent changes. Another potential reason for the wide

recording, and reevaluating" (i.e., charting for its own sake,range of variation in the proportion of critically ill patients canrather than charting for the patients). It is suggested that nurses

be attributed to hospital-developed nursing acuity standards

revisit the system of nursing records, documentation, andthat are different from the above-described acuity standards

reporting in order to sort out unnecessary or redundantutilized in this study. These hospitals may have employed theirinformation critically. We can use this valuable one-quarter ofown hospital-specific standards for this survey.

nursing time efficiently in order to improve the quality ofnursingby

discontinuing

ineffective

activities

In future studies of inter-hospital comparisons or trend(i.e.,

analyses on patient acuity levels, we need to develop a uniform

documenting or conveying information that will never be

nursing acuity classification system and standards, and to makeutilized for patient care afterward) or by modifying activities sosure that each participating hospital uses that uniform systemthat the utility of charting, reporting and staff communicationand standards.

can be improved. Additionally, it is greatly expected by nurses
Conclusions

and hospital administrators that the advancement of computer
technologies will improve the efficacy of nurses' charting,Nursing personnel in university hospitals allocated nearlyreporting, and information management, such as searching for

50% of their nursing time to direct patient care. An increased

and sorting out necessary information.

proportion of direct patient care such as this can be interpreted
as a favorable effect of the ongoing improvements in nursing
care delivery systems at university hospitals. Nursing

A Necessity for a Uniform Nursing Acuity Standard:
The majority of nursing personnel working at university

departments are expected to improve their services and quality

hospitals recognize that patient acuity has been increasing inof nursing care further in order to address the following current

recent years. The proportion of "(the most) critically ill"and future issues: the advancement of high-tech medical

patients with nursing acuity levels of "A-1" or "A-1, A-2, andtreatment; the increased severity of patients; the increased

B-1" in each participating hospital had a wide range ofnursing service demands due to shortened lengths of stay; andvariations. Additionally, direct patient care time for suchexpectations

critically ill patients in each participating hospital also had acompetence of nursing departments. The results of this survey

wide range of variations. Several reasons for this situation areprovide baseline data for future directions of improvements in

described below.

nursing services at university hospitals and benchmark data to

First, for example, as a result of the advancement in high-economic

efficiency

andmanagement

evaluate the current quality of nursing at tertiary care hospitals.

tech medical treatment and early mobilization (getting patients

国立看護大学校 紀要 第 1 巻 第 1 号 2002 年

in― 24 ―

Nursing Time at University Hospitals

References5）Ministry of Health and Welfare: Annual Report on Healthand Welfare 1998-1999, 369,

1）Institute of Medicine: Staffing and quality of care in

Japan International

Corporation of Welfare Services, 2001, Tokyo.

hospitals. In Nursing Staff in Hospitals and Nursing6）Matsuda A, Iwamatsu M, Saida A, Anzai M: [Time-study

Homes: Is It Adequate? 92-127, National Academy Press,

analysis on ward nursing in an university hospital,]

1996, Washington, DC.

Hospital Administration, 32(4), 353-360, 1995. (in2）Kanda K: [Proportion of high-acuity patients according tohospital characteristics,] J Jpn Acad Nurs Sci, 15(4), 9-14,

Japanese)
7）Hendrickson G, Doddato TM, Kovner CT: How do nurses
use their time? J Nurs Adm, 20(3), 31-37, 1990.

1995. (in Japanese)
3）Statistics

andInformation

Department,

Minister's8）Quist BD: Work sampling nurse units. Nurs Manage,

Secretariat, Ministry of Health and Welfare: [Survey of23(9), 50-51, 1992.

Medical Institutions and Hospital Report in 1996,] 494-9）Prescott PA, Phillips CY, Ryan JW, Thompson CO:

499, Kousei Toukei Kyoukai [Health and Welfare

Changing how nurses spent their time, Image J Nurs Sch,

Statistics Association], 1998, Tokyo. (in Japanese)23(1), 23-28, 1991.

4）Takahashi M, Kanda K, Maitoko M, et al.: [Schemes10）Burke TA, McKee JR, Wilson HC, Donabue RMJ,

driving the project of improvements in nursing services. A

Batenhorst AS, Pathak DS: A comparison of time-and-Grant Report to the Ministry of Health and Welfare,]motion and self-reporting methods of work measurement,

1993. (in Japanese)

J Nurs Adm, 30(3), 118-125, 2000.

― 25 ―J Nurs Studies N C N J Vol.1 No.1 2002

菅田勝也*1，小澤三枝子 *2，入村瑠美子 *3【要旨】

大学付属病院における看護要員の業務実態を具体的に調査し，大学付属病院における看護のあり方や

看護業務改善など，看護に関わる諸問題に対処するための資料を得る．
自記式調査法により看護要員個別調査（平日 2 日，日曜日 1 日の全勤務者の業務時間）と患者個別調査（平日 1 日の全入院患者に対する直接ケア時間）を実施した．調査対象は全国 42 国立大学病院本院のうち地区や開設年次等を考慮して選んだ 16 病院で，調査時期は 1995 年 5 〜 6 月である．
16 病院の平均病床数は 830 床，看護要員個別調査日の 1 病院あたり看護要員勤務者数対入院患者数は，平日は296 対 719，日曜日は平均 193 対 690 であった．最重症患者（常に寝たままで絶えず観察が必要）の割合は，平日 10%，
日曜日 8% であった．看護要員が多くの時間を充てた業務は，平日は「患者の世話」に 30%，
「診療介助」に 14%，
「記
録・報告・連絡」に 25%，日曜日は同順で 34%，16%，27% であった．患者個別調査日の患者１人あたり直接ケア時間
は 107 分で，時間帯別割合は日勤帯 55%，準夜勤務 26%，深夜勤務 18% であった．看護度が高い患者群ほど直接ケア
時間の日勤帯と夜間の割合の差が小さかった．
看護要員の業務時間の半分近くが直接ケアに充てられていたことは，大学病院で進められてきた看護業務改善の成果とみることができる．この調査結果には，今後の大学病院の看護業務改善のベースラインという意味と，高次機能病院のベンチマークという２つの意味がある．
看護業務時間，大学病院，自記式調査，直接ケア

国立看護大学校 非常勤講師（東京大学大学院）*2

国立看護大学校 基礎看護学〒 113-0033 東京都文京区本郷 7-3-1
東京大学大学院医学系研究科看護管理学分野
電話：03-5841-3523
FAX：03-5841-3376
メールアドレス：kanda-tky@umin.ac.jp*3

東京大学医学部附属病院看護部

国立看護大学校 紀要 第 1 巻 第 1 号 2002 年― 26 ―*1